| NPI | 1144607169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARITY DAWN FANCHER Operations Admin 715-842-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist Clinical | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2025-05-13 |